Amira and her husband Aziz hold their 4-month-old daughter Rahf at the therapeutic feeding centre in Sabeen Hospital, in Sana'a, Yemen.

By Sven G. Simonsen

SANA’A, Yemen, 13 July 2012 – Odai is recovering from severe malnutrition. At 4 years and 10 months old, he weighs a mere 10 kg.

He had experienced bouts of vomiting and diarrhoea for weeks. Eleven days ago, his grandmother, Katiba, brought him to the therapeutic feeding clinic at Sana’a Sabeen Hospital.

“I thought he would die the next minute. But he is better now,” she said. “He has returned to life.”

Malnutrition considered normal

Among Yemen’s children, sickness is normal. In the governorates of Hajjah and Hodeidah, UNICEF-supported surveys have found that 30-40 per cent of children under age 5 had suffered from diarrhoea in the two weeks preceding the survey. Nationwide, 43 per cent of children under 5 are underweight, and an estimated 967,000 children suffer from acute malnutrition. In certain areas of the country, the acute malnutrition rate exceeds 30 per cent, twice the emergency threshold.

In recent months, UNICEF has rapidly scaled-up nutrition interventions in Yemen. More than 500 health facilities now provide therapeutic nutrition interventions with UNICEF support, and there are more than 250 operational supplementary feeding programs.

“Malnourished children like Odai are so fragile, they are like glass,” said Dr. Rajia Sharhan, a paediatrician and a health and nutrition specialist with UNICEF, feeling Odai’s bloated stomach. “If they are fed too much, they can have organ failure.”

Odai, 4, is being treated for severe malnutrition at Sabeen Hospital in Sana'a, Yemen.

Odai has three siblings, including a twin brother. “It is very likely that his brother is also malnourished,” Dr. Sharhan said. “Underweight and stunting is so common in Yemen, it is not identified as a problem. This boy was taken to hospital because of vomiting and diarrhoea, not because he was thin.”

Breastfeeding key to health

Improving child feeding practices is an integral part of UNICEF-supported nutrition interventions across Yemen. Perhaps the most important message that UNICEF seeks to communicate is that newborn children should be exclusively breastfed for the first 6 months.

In the room next to Odai’s, Fathia sat beside her 11-month-old twins Abdul and Amat. They weighed only 3.1 kg each when they arrived a week ago. They were fed only water and sugar for the first three days after they were born – a practice common in Yemen, where many believe that the mother’s first milk is not good. Fathia later combined breastfeeding with bottle feeding.

But in Yemen, poor water quality and deficient hygiene can make bottle feeding harmful. For the last 2-3 months, the twins have had bouts of diarrhoea. They were diagnosed with severe malnutrition complicated by acute respiratory illness.

Fathia and her husband, a street vendor, have spent 70,000 rials (US$ 330) in other hospitals. “It has really destroyed our family economy,” she said.

‘Now I know I have to breastfeed’

Amira and Aziz told a similar story. “I breastfed Rahf for the first two months, then I stopped,” Amira said. As a farmer, she had to quickly resume work in the fields. Rahf, now 4 months old, was bottle-fed by family members, and her health began deteriorating a month ago.

Last year, Amira lost another child, a 4-month-old boy. “He died from this same condition… Now I know I have to breastfeed,” she said, but, “I’m not sure if I can do it. I have to work.”

Salha, who had been discreetly breastfeeding her child in the opposite hospital bed, intervened. “I am like you; I am a farmer,” she said to Amira. Turning to Aziz, she said, “Why don’t you let your wife stay at home, to cook and breastfeed the child?”

Salha has given birth to seven children; four of them have died, all from conditions related to malnutrition.

A chance to survive

In the paediatric ward, where malnourished children with complications are treated, Gumashe explained that she was married at age 11. Today, she is 13. She was at the hospital with her 6-month-old son Seif.

Gumashe breastfed Seif for the first two months, but then doctors prescribed bottle feeding, saying her milk was not sufficient. Seif has suffered from diarrhoea for the last three months.

“We have been to so many hospitals,” Gumashe said. “All this medicine they prescribed for him.” She pulled out a bag so full of medicines, even the nurses were shocked.

But with proper treatment, Seif finally has a real chance of survival. And with improved feeding practices, he will be able to grow and, with luck, thrive.